LONGITUDINAL ANALYSIS OF TRENDS IN SMOKING HABITS AND IMPACT OF CHANGES IN SMOKING AND BODY MASS ON LUNG FUNCTION

The tobacco epidemic has been the driving force to establish the foundation of the battle against tobacco use and effective public policy measures using simple preventative and targeting strategies against nicotine dependence. However, smoking is still a widespread phenomenon at various forms in recent years and the assessment of smoking trends and behavioral changes will reflect the attributes of impacted age groups to identify smoking prone populations and lead to strategize preventative and recovery systems. We analyzed the long-term trends in smoking initiation and cessation in order to identify age- and gender specific changes in Australian population over a 70 year timeline, utilizing the data from two longitudinal studies on the general population from the Tasmanian Health Study (TAHS) and the Busselton Health Study (BHS). To determine the effect of both smoking status and weight change on lung function in the general population, we also performed an analysis on lung function outcomes modulated by smoking behavioral changes relative to weight gain over 20 years in the European Community Respiratory Health Survey (ECRHS). We estimated trends in the rates of smoking initiation (number of incident smokers divided by total time at risk) between 1920 and 1989, by sex and age groups (11-15, 16-20, 21-35 years). The rates of smoking initiation during young adolescence (11-15 years) increased steeply between 1925 and 1980 in females. After being relatively stable, they slightly increased after the 70’s also among males. In the same period, the rates showed a completely different trend between males and females during late adolescence (16-20 years): initiation rates in males decreased steeply, whereas they steadily increased in females. Smoking initiation during late adolescence peaked in the ‘40s for males and decreased afterward, while in females initiation increased until the mid-‘70s. These results reflect the shift of smoking trend from boys to girls among teens, and they highlight a sharp increase in smoking initiation among Australian female adolescents during the ‘70s and ‘80s that is consistent with information available from Europe. Our findings also showed that quitters with high weight gain had faster lung function decline compared to quitters with moderate weight gain at older ages, but not at younger ages, highlighting the importance of early smoking cessation and weight control among quitters. Using a historical perspective, this longitudinal study documents early signs of the successful implementation of tobacco control measures in the Australian population. It underlines the importance of encourging positive awareness and implementing strategies for early smoking cessation, parallel to promoting prevention and stronger intervention strategies in youth. In addition, empowering and monitoring active and healthy living can improve the outcomes of smoking cessation on lung function trajectories and mitigate the future risk of diseases like asthma and COPD.